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Home My WebLink About9301-z FOR~ NO. 2 TO~N OF $OUTHOLD BUILDING DEP~RTMENT TOWN CLERK'S OFFICE $OUTlfOLD, N. Y. N.o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P1~EMISES UNTIL FULL COMPLETION OF THE WORK ,AUTHORIZED) 9301 Z Date ~'~lgl~ ~0 19 ~ Permission is hereby granted to: ~rules & lk,~ ,a~.~mennse~n tO .............. , ..... d ..................................... - ,~ ~: ................... 7,...~ .......................................................................................................................... ~ ........... at premises I~at~ at ~OW ~ ....... ' , ~¢,~¢ pumuant ~o ~lication dat~ 19.. ........................ ;, --.-;~ ~: j'"", ............. FORM NO. ~ TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled zn typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2 Fznal approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddmgs, Industnal buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspechon of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certihcate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .......... ................ New Building ....... ~.. .......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .....~...~.~......~.~.~...~..~..~.Q..t~......~.q~.~,.~...~~,.~M~.~..~..~...~.... Owner Or Owners Of Property ...~...~.......~..~ ....... ~J..~.4~.~ Subdivision ................................................................L.] Lot No ............. Block No ............. House No..~.~..Q Permit No.q..~0...~."~.. Date Of Permit ..~"./.~.9.~..-~...~. Applicant ...~., ..... ~.~4_~..~.~.G~~. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........ ~ ............................. Fee Submitted $ ...... .,~.;.(~.~J. ............... Construction on above described building and permi~ meets all/~l:>,~cable~ codes and regulations. Applicant ...~ ......... t:~~ ..... ~'~..~',.~¢,~¢..~.~,. & .~Z,~.L,;~. ~.. ................ Sworn to before me this ......... /:f... o, .......... Notary Public ...~~~~ County THE,,NEW YORK BOARD OF FIRE UNDERWRITERS ' ,/ 'I' ~ BUREAU OF ELECTRICITY,'~.~, ~-- ak -', ' ," ,'," 85 JOHN STREET, NEW yORK. NEW YORK I003a THIS only t~ electrical ~quipment . ~scdb~ bel~ ~d i~r~d~'~'th~ a~?ant ~d on the aba. applwatmn number ,n t~ prem~ses of Bungalow ~hane, 700' e/o' Marratook~ Rd. ~ Jules Ad~igenssens, s/si~de . ~, ~ ~ Mattitue~ L.I. ,'~ ~ ~ ": "' was examlned on ,' ' ---- -- ~ ~ -- ~ ~p o~ f qun~ $o be m complmnc¢ W~ta the requirements oJ t~ts ~oard,, ,,,,~ ,, . , ~ FIXTURE SWITCHES' FIXTURES OUTLETS ~ ~I-UO~ESCENT 15 27 ~7~'~ " ~i DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS OVENS DISH WASHERS FANS TIME CLOCKS UNIT HEATERS DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OFCCCOND OF HI LEG OF NEUTRAL , ':1:,! , , ~/0 2 Smoke Detector This certificate must not be altered in any manners, return to:the'off ce ,of the Board f incorrect.: l~sp~ctors may credentials· API~OVED AS NOTED 765-2660 9AM to 4PM FOR REQUIR- iI' : il E L E V/~T~ld~ ?u ,!